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HIV/AIDS

HIV/AIDS. Presented by Libby Sells Lisa Sharp-Gomez. Overview. Disease Etiology Diagnosis Treatment Patient Assessment Diagnosis Intervention Treatment Medical Nutrition Therapy Monitoring and Evaluation Prognosis Resources. Disease Description and Etiology. Definition

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HIV/AIDS

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  1. HIV/AIDS Presented by Libby Sells Lisa Sharp-Gomez

  2. Overview • Disease • Etiology • Diagnosis • Treatment • Patient • Assessment • Diagnosis • Intervention • Treatment • Medical Nutrition Therapy • Monitoring and Evaluation • Prognosis • Resources

  3. Disease Description and Etiology • Definition • HIV is a retrovirus that targets the CD4 cells of the immune system (the T-Helper cells) and turns them into viral factories for HIV reproduction • Transmission • The HIV virus is transmitted from person to person via infected body fluids. This includes sexual contact, infected needles, blood transfusions and mother to child. • AIDS is the advanced manifestation of HIV that has the potential to make a person vulnerable to opportunistic infections

  4. Diagnosis of HIV and AIDS • Diagnostic tests • ELISA - Enzyme Linked Immunoabsorbant Assay • Western Blot • IFA- Indirect Immunoflorescent Antibody • RIPA - Radio Immunoprecipitation • PCR - Polymerase Chain Reaction • Alternative diagnostic tools • Urine and oral fluid tests • Finger prick

  5. CDC Clinical and Immune Cell Categoies of HIV Infection

  6. HIV and AIDS Treatment • There is no cure. Treatment is by symptom management only. • Treatment includes anti-viral medications, prevention and treatment of opportunistic infections (OI) and restoration of nutritional status • Treatment is multi dimensional involving physicians, dietitians and psychologists • A person’s geno- and phenotype can help determine the appropriate therapy.

  7. Anti Retro Viral Medications • The goal is to lower the viral load (copies of the virus per ml of blood) • Medications interrupt the viral life cycle, thus decreasing the spread from cell to cell within the body. • HAART – Highly Active Anti Retroviral Therapy • Includes 3 or more ARV medications • Side Effects: • Nausea, diarrhea, appetite loss, lipid alterations and glucose intolerance. • Lipodystrophy

  8. Opportunistic Infections • Examples: Pneumonia, Encephalitis, tuberculosis, Influenza, HPV, Hepatitis A and Band Malaria • Early detection is important • Vaccines are useful in preventing some infections like HPV and Hepatitis

  9. AIDS Wasting Syndrome Treatment • Defined as weight loss greater than 10% of body weight combined with fever or diarrhea for more than 1 month. • Or 7.5% weight loss in 6 months • Megestrol Acetate and Dronabinol are used to increase appetite and reduce nausea. • Strength building exercise can be used to retain muscle mass • May also be managed with Androgens and Growth Hormones • This hormone therapy is also used to manage lipodystrophy

  10. Alternative Supplements and Oral Therapies

  11. Patient Assessment and Etiology • Etiology – Unknown • Terry Long , 32 years old. African American male, HIV positive for 4 years, diagnosed with Stage 3 AIDS and oral thrush. Family history of CAD and HTN, stopped smoking 5 years ago, consumes 2-3 drinks 3-4 x/week. • Taking multivitamin, vitamin E, vitamin C, ginseng, milk thistle, Echinacea, St. John’s wort, prescribed HAART regime with Atripla and Fluconazole IV • Anthropometrics • Weight – current 151, usual 165, % UBW 91.5 BMI 19.9 kg/m2 • TSF 7mm < 50 percentile • BP 120/84 • 12.5% body fat

  12. Patient Assessment and Etiology

  13. Patient Assessment and Etiology • Clinical • White patchy exudate in throat • Dry, warm, flaky skin • Rhonchi in left lung • Hyperactive bowel sounds • Diet • Current - Liquid and soft foods due to mouth pain • Usual diet - 2000 kcal intake • 52% from carbohydrates • 37% from fats • 15% from protein • 540 non nutritive calories from alcohol • Current Diet – 860 calories • 70% from carbohydrates • 25% from fat • 5% from protein

  14. Patient Diagnosis • 1) Unintentional weight loss (NC-3.2) related to HIV/Aids, difficulty swallowing and inadequate caloric intake as evidenced by BMI of 19.2, 91% UBW and recent weight loss. • 2) Difficulty swallowing (NC-1.1) related to oral thrush as evidenced by patient’s complaints and 24 hour diet recall. • Stage 3 AIDS with oral thrush.

  15. Patient Intervention and Treatment • Multidisciplinary approach to treatment • Priorities: concern for diabetes, insulin resistance, hepatitis, renal and pancreatic malfunctions, cardiovascular disease and osteoporosis

  16. Goals • Prevention of food, drug and supplement interactions • Restoration and maintenance of nutritional status • Management of signs and symptoms • Appetite loss • Diarrhea • Heartburn/reflux • Nausea/vomiting • Oral lesions

  17. Medications/SupplementsTaken By Patient

  18. Physical Activity Recommendations Exercise known to improve muscle volume and function Regulates lipid and energy metabolism For patients with HIV/AIDS may lessen the loss of muscle mass in wasting conditions. Recommendations should complement diet prescription Exercise should include a combination of aerobic and resistance training.

  19. Medical Nutrition Therapy • As infected cells in the gut increase, there is an increased risk of malabsorption and malnutrition increase • ARV’s can increase blood lipid levels and inflammation, diabetes and hypertension can put patients at an increased risk for cardiovascular diseases. • HIV can affect all body systems causing a variety of nutritional complications.

  20. Nutrient Requirements • Fluids: 1 ml/kcal = 3 L per day • Calories: 2900 – 3300 actual calculated 2400 calories, but increase 20-50% due to OI. • Protein: 59 grams based on current body weight, or 145 grams based on 20% of 2900 calories. • Fat: Less than 97 grams of total fat and less than 26 grams saturated fat. • Vitamin and mineral recommendations based on individual needs and deficiencies

  21. Goals and Intervention • Goal 1: Increase weight to at least UBW of 160-165 pounds, with ultimate goal of 184 pounds (ideal body weight). • Intervention 1:Increase caloric intake to at least 2900 calories, which will allow a weight gain of at least 1 pound/week. Do this by consuming smaller, more frequent meals, add in protein shakes and hidden sources of calories. • Goal 2: Alleviate signs and symptoms associated with oral thrush • Intervention 2: Avoid alcohol, high sugar and yeast foods, and foods that are hot, spicy, tough, and difficult to chew and swallow.

  22. Sample Diet and Modifications

  23. When is Enteral Nutrition Necessary? • Enteral Nutrition may be considered when BMI drops below 18.5 kg/m2 • Enteral nutrition may be considered when a weight loss of greater than 5% occurs in a 3 month period. • Enteral nutrition may be considered when BCM (Body Cell Mass) decreases by more than 5% in 3 months. • Can be considered if Oral Thrush worsens to the point that patient is unable to consume adequate nutrition from food sources • Can be considered in malnourished AIDS patients with chronic, uncontrollable diarrhea.

  24. Education and Counseling • Focus on diet modification and food safety • Provide patient with food/drug and supplement interactions information and symptom management information • Food safety suggestions • What would you advise?

  25. Monitor and Evaluation • BMI, body composition changes, skin fold measurements • Pertinent lab values: CD4 count, viral load, albumin, glucose, cholesterol, etc. • Signs and symptoms like diarrhea and fatigue • Development of additional opportunistic infections • Oral thrush, pneumonia, AWS • Evaluate patient’s adherence to diet modifications and exercise

  26. Prognosis • Weight loss and AWS is not inevitable. • Opportunistic infections and other complications of AIDS will always affect nutritional status, so nutrition therapy and continuing education will be important for patient’s entire life • Life expectancy depends on how early patient began ARV, and how well they are able to prevent nutritional complications and OI. • Life expectancy is near normal today if disease is properly managed

  27. Resources • ResourcesAlcohol and HIV/AIDS. National Institute of Alcohol Abuse and Alcoholism. (2002). • http:pubs.niaaa.nih.gov/publications/aa57.htm • Body Fat Percentages. Vanderbuilt University (2012). http:// healthandwellness.vanderbilt.edu/news/2011/09/body-fat-percentage/ • HIV. Centers for Disease Control and Prevention. (2013). http://www.cdc.gov/hiv/. HIV Infection. U.S. National Library of Medicine. (2012). http://www.nlm.nih.gov/ • medlineplus/ency/article/000682.htm • Nelms, Sucher, Lacey, Roth; (2011)Nutrition Therapy & Pathophysiology, (2nd ed.) Belmont, Ca, Brooks/Cole Cengage Learning • Mahan, Escott-Stump, Raymond, (2012) Food and the Nutrition Care Process, St. Louis, Mo, Elsevier Saunders

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